One Cardiology Center, Two Technologies and Countless Young Lives Saved or Improved

A family from Pennsylvania’s Plain People community, which consists primarily of Amish and Mennonite families, recently took their child to Cardiology Care for Children (CCC), a small yet regionally renowned practice in Lancaster. They’d been referred by the girl’s pediatrician, who was concerned about her irregular heart rate. At CCC, sonographer Rebekah Tomredle skillfully scanned the patient’s chest with a new diagnostic ultrasound system the center had acquired only a few months prior. Upon interpreting the echocardiogram, pediatric cardiologist Devyani Chowdhury, MD, noted that the child had a Sinus of Valsalva aneurysm, which would require a surgical intervention.

“This was a self-pay patient whose family didn’t have much in the way of resources,” recalls Chowdhury. Had the echo not been performed properly and with state-of-the-art equipment, she adds, “we would have missed that finding. And the patient would have most likely never had another echo” because of their financial constraints.

“We may have prevented a sudden death,” Chowdhury says, “in the second or third decade of that patient’s life.”

This is just one case that Chowdhury, CCC’s medical director, and Tomredle, its technical director, are quick to describe when asked to recall recent episodes of care in which highly advanced technology made it possible for them to save or improve a young person’s life.

Their memories are fresh for two reasons. For starters, all children with heart conditions are unforgettable to the healthcare professionals who care for them. Secondly, Chowdhury and Tomredle selected the technology after long and careful tryouts of multiple products on the echocardiography market.

What’s more, when they began using the system, they made CCC one of the first provider organizations in the U.S. to pair this particular premium ultrasound machine—Hitachi’s Lisendo 880 with 2D and 3D capabilities set up specifically for cardiovascular indications—with Hitachi’s new-by-acquisition PACS offering, the cloud-based VidiStar system.

That was last May. Eight months later, Chowdhury and Tomredle report they are delighted with the performance of Lisendo, VidiStar, the combined might of the two technologies together—and, maybe most of all, the people of Hitachi Healthcare Americas.

“Hitachi’s support teams for both Lisendo and VidiStar have done pretty much everything we’ve asked them to do,” says Tomredle. “And the company wants to make as high-quality a product as they can, too.”

“And the Hitachi leadership is honest,” adds Chowdhury. “It was a refreshing surprise.”

Enclave of Excellence

The topnotch care that children and their families receive at Cardiology Care for Children is, in many ways, a direct reflection of Chowdhury’s combination of vast experience and deep commitment to never compromise quality of care. She’s been practicing her specialty for several decades, including the last 11 years in Lancaster. She’s a steady researcher as well as a busy clinician. And she’s nationally known in pediatric cardiology circles for, among other contributions to the field, her ongoing work with the American College of Cardiology, Adult Congenital and Pediatric Cardiology Quality Section. She has been the leader in the field for development of quality metrics for ambulatory pediatric cardiology care.

As for the CCC, around 3,500 patients walk through its doors each year. Close to 2,000 of them receive cardiac ultrasounds, and some 200 to 500 of the resulting echocardiograms, or “echoes” for short, are incorporated into patient-centered clinical research studies to be lead-authored or co-authored by Chowdhury.

The county served by the center is home to around half a million people, including the Plain People population. This unique population pays for their own medical care (no health insurance), so access to affordable care is essential. At CCC these patients receive high quality care at an affordable cost, making it a true value-based experience for the patients.

“We are an independent practice that provides honest and transparent high quality patient centered care at a community level. Patients feel valued in our practice and are very confident that they will get a true, unbiased opinion.” Chowdhury says. “We would send a patient all the way to California if that’s what it takes to obtain the best surgical results for the child. We always try to connect the child’s heart with the best surgical hands. Every child is a part of our extended family.”

It was that guiding goal that prompted Chowdhury and Tomredle to go shopping for new echocardiography and PACS systems in early 2018. They decided second-to-none performance, ease of use and efficiency would all be prerequisites in both categories.

“Our studies are being looked at by tertiary care centers, and we don’t want to be labeled as a low-quality private practice that is doing horrible echoes that everybody has to do over,” Chowdhury says. “We want to be top of the line with quality. We are very sensitive to the time and money spent by our patients and feel obligated to deliver only the very best. Offering affordable care is no excuse for absence of quality.”

This uncompromising approach to quality and service led Chowdhury and Tomredle to narrow the field of ultrasound contenders until, finally, only one remained: Hitachi’s Lisendo 880. VidiStar was a natural simultaneous selection, since their old PACS only worked with its own vendor’s ultrasound machine.

Their top priorities for imaging and reporting were speed, versatility and a cloud-based solution that would let Chowdhury view images and reports while traveling, working from home or sitting at any computer workstation in the office. In VidiStar, they got all of that and more, Tomredle says.

“One thing I love about the VidiStar platform is that, when we have different types of studies sent to us—MRIs, CTs, cardiac cath images—we can load all of that into our cloud-based PACS and link it to the patient,” Tomredle adds. “And then everything Dr. Chowdhury needs is right there at her fingertips. We don’t have to run around to different computers, worrying about what plays well with PCs, what plays well with Macs and all of that.”

Prior to May 2018, Tomredle says, that kind of running around was a necessary headache. Today, Chowdhury volunteers, that’s all in the past.

Fast-forward to the winter of 2018-19. Having gained hands-on experience with the Lisendo 880 and VidiStar PACS for the better part of a year—for both purely clinical and research-related work—Chowdhury and Tomredle are confident offering several observations on each technology.

Ultra-Fine Cardiovascular Ultrasound

Chowdhury and Tomredle in their own words on Lisendo 880:

Procedures are blazingly fast. “I can create a preliminary report in VidiStar from a normal echo in less than one minute, where it would take five to 10 minutes on our old system,” Tomredle says. “A big portion of that was dealing with the machine. I didn’t like measuring on our old machine. It was very clunky and it took up time I didn’t have. It was always a matter of, ‘I need to get the patient done because another patient is waiting for an echo.’ It was just a revolving-door kind of scenario. The Hitachi machine makes it a lot easier to get the measurements done. We can just go through and get the measurements as we’re doing the echo.”

Innovations have added much value without sacrificing any overall utility. “The Lisendo brought us two new technologies,” Chowdhury says. “One was Vector Flow Mapping (VFM) and the other was LV eFlow.” (The former sharply visualizes endocardial borders of the left ventricle, while the latter dynamically shows blood flow through the heart and vessels.) “Those were two important features. But at the same time, we didn’t want to give up quantification of myocardial function using 2D strain. The combination of those three capabilities made the Lisendo very attractive to us.”

More visual information is better visual information. “We can see more with the Hitachi Lisendo images than we could see with any other system we tried out,” Chowdhury says. “This was not a casual decision. We had numerous [vendor] people come into the office, and we imaged our patients simultaneously on several machines at least two or three times prior to making our decision.”

Customization perfects protocols. “This machine really is easy to use,” Tomredle says. “The probes are light, there’s no weight dragging on your wrist and you get the images you need quicker. Plus it’s very customizable, with touchscreen buttons and modes. You can customize the machine to your specific protocol. If there are certain modes or buttons you use more, you can bring those to your primary screen and position them on the screen where you want them.”

It's good to have features to grow into. “We really like certain features like Dual Gate Doppler, which gives us the ability to Doppler two areas of the heart simultaneously,” Chowdhury says. “There’s also a fetal probe. We are very happy with the fetal probe and its capabilities.”

Workflow Wunderkind

Chowdhury and Tomredle in their own words on Hitachi’s VidiStar PACS and reporting system:

There’s nothing like doing everything from anywhere at any time. “Every other cloud-based PACS we considered allowed us to view studies remotely but would not allow us to do measurements or make changes in the reports,” Chowdhury says. “VidiStar was the first PACS we came across that let us do everything—measurements on the echo report, finalizing the echo report, faxing the echo report, sending the entire study, creating different groups like research, etc., within the system, scoring the studies to get the quality metric data etc. It’s like sitting in your own office with your own desktop no matter where you are.”

Embedded quality metrics facilitate quality assurance. “We need to submit data to the American College of Cardiology on quality improvement, because we need that for our accreditation and I need it for my maintenance of board certification,” Chowdhury says. “So I asked Hitachi to build the quality metrics (quality assurance) metrics into their reporting system. And now we are about to start submitting the data. We will be pulling data on 20 patients and submitting to Qnet. And the quality metric now takes about one minute where it would otherwise have taken from 20 to 25 minutes per study. The moment a report is done, we can get a score.”

Such metrics also help lift the entire field of pediatric cardiology. “As a leader of quality science in my field, I feel that if I’m going to ask other programs to do this—and it will increase their cost of care in terms of manpower and time—then I have to offer them a tool,” Chowdhury notes. “I can say, ‘Well, you had the metric right away.’ And that really makes a difference.”

What a difference a streamlined workflow makes. “Workflow in VidiStar is very quick,” Tomredle says. “I love the new copy forward and trending upgrades. With copy forward, we have these patients who are really complex—they might have had a lot of surgeries, for example—and that produces so much data to re-populate into your study. With copy forward you can automatically enter the patient’s entire prior report, duplicate it into a new report, make changes only where appropriate and it’s done. That’s a lot better than going through and trying to remember every little detail.”

Trending is empowering. “The trending feature is great, because you can look back at the history of a certain measurement,” Tomredle says. “It goes through all prior reports and gives you a graph showing how the measurement has changed over time”—thus providing vital clinical insights to help guide care for patients.

Which brings the discussion back to recent cases with good outcomes made possible by CCC’s investment in technology. Chowdhury and Tomredle recall a patient whose pulmonary arteries were difficult to visualize due to the surgeries she’d had.

“Our previous machine could never get good color Doppler images to let Dr. Chowdhury really assess them well,” Tomredle says. “We would have to send certain patients for additional testing or advanced imaging (MRI). With the new machine, we have excellent color Dopplers, so this patient didn’t need to go for additional testing to assess the pulmonary arteries. That saved the patient and her family hassles and higher financial burden as well.”

To this Chowdhury adds: “I really think Hitachi is in sync with how clinicians and researchers use technologies today. Usually medicine lags behind other industries. I am very happy to see that all these capabilities are right there for us and that we have been able to make them a part of our practice.”